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Release Notes:
Measure Information Form
Version 2010A1

Measure Information Form

Measure Set: Blood Management(BM)

Set Measure ID: BM-06

Performance Measure Name: Preoperative Anemia Screening

Description: Selected elective orthopedic, cardiac and hysterectomy surgical patients who had documentation of preoperative anemia screening 14 – 45 days before Anesthesia Start Date.

Rationale: Development of formal protocols for preoperative testing of hemoglobin (hgb) for potential high-blood loss elective surgeries could be used to identify and intervene for optimal management of blood resources. Preoperative anemia often goes unrecognized and untreated unless tests are ordered in advance of a planned surgery. Early recognition of anemia offers patients an opportunity to receive the most appropriate transfusion-sparing strategy, and avoid the risk of a potential transfusion. Researchers have shown that preoperative hgb and hematocrit can be used as predictors of outcome for specific types of patients such as cardiac artery bypass graft or orthopedic surgery. In a study by Salido, orthopedic patients with a preoperative hemoglobin <13 g/dL had four times the risk of transfusion than those with a hemoglobin level between 13 g/dL and 15 g/dL.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Patients with preoperative anemia screening 14 - 45 days before Anesthesia Start Date
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: Selected elective surgical patients

Included Populations:
  • Discharges with an ICD-9-CM Principal or Other Procedure Codes of selected surgeries as defined in Appendix A, Tables 2.2, 5.01, 5.02, 5.08, 5.11, 5.22, 5.23, 9.1 or 9.9.

Excluded Populations:

  • Patients less than 18 years of age
  • Patients with Preoperative Anemia Screening Date less than 14 days before Anesthesia Start Date

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: These data may be used to evaluate specific patient groups at high risk for a blood transfusion that did not have their pre-operative hemoglobin and/or transfusion testing completed and/or documented prior to surgery. The data could be further analyzed based on physician or type of procedure. Patients who are not included in the numerator could be tracked to see if there were any adverse outcomes due to the lack of preoperative anemia screening.

Sampling: Yes. For additional information see the Population and Sampling Specifications Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

  • Saxena S, Nelson JM, Osby M, Shah M, Kempf R, Shulman IA. Ensuring timely completion of type and screen testing and the verification of ABO/Rh status for elective surgical patients. Arch Pathol Lab Med. 2007;131:576-81.
  • Friedberg RC, Jones BA, Walsh MK. Type and screen completion for scheduled surgical procedures. A College of American Pathologists Q-Probes study of 8941 type and screen tests in 108 institutions. Arch Pathol Lab Med. 2003;127:533-40.
  • Roback JD, ed. Technical manual. 16th ed, Bethseda, MD: AABB, 2008.
  • Salido JA, Martin LA, Gomez LA, et al. Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery; analysis of predictive factors. J Bone Joint Surg. 2002;84: 216-20.
  • Rady MY, Ryan T, Starr NJ. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med. 1998;26: 225-235.
  • Magovern JA, Sakert T, Magovern GJ et al. A model that predicts morbidity and mortality after coronary artery bypass graft surgery. J Am Coll Cardiol. 1996;28: 1147-1153.
  • Campbell DA, Henderson WG, Englesbe, MJ, Hall BL, O’Reilly M, Bratzler D et al. Surgical site infection prevention: the importance of operative duration and blood transfusion-results of the first american college of surgeons –national surgical quality improvement program best practices initiative. J AM Coll Surg 2008;207:810-820.

Measure Algorithm:

Attach file

Related Topics

Measure Information Form BM-06
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)